Personality disorder

Personality disorder

Personality disorders are conditions where an individual differs significantly from an average person. This may be related to how they:

• think
• perceive
• feel
• relate to others

Changes in how a person feels and distorted beliefs about other people can lead to odd behaviour. This can be distressing and may upset others.

Common features of a personality disorder

Common features of a personality disorder include:

• being overwhelmed by negative feelings like distress, anxiety, worthlessness or anger
• avoiding other people
• feeling empty and emotionally disconnected
• odd behaviour
• difficulty maintaining stable and close relationships, especially with partners, children and professional carers
• periods of losing contact with reality

Some people may also have difficulty managing negative feelings without self-harming. This can include abusing drugs and alcohol or taking overdoses. In rare cases, it may include threatening other people.

People with personality disorders often experience other mental health problems. This includes depression and substance misuse.

Symptoms typically get worse with stress.

When and why personality disorders occur

Personality disorders are common mental health problems.

They usually emerge in adolescence and continue into adulthood. They may be mild, moderate or severe. People may have periods of “remission” where they function well.

Personality disorders may be associated with genetic and family factors. Experiences of distress or fear during childhood, like neglect or abuse, are common.

Many people have only mild conditions so only need help at times of stress (such as bereavement). People with more severe problems may need specialist help for longer.

Types of personality disorder

There are different types of personality disorders.

Paranoid personality disorder

A person with a paranoid personality disorder is extremely distrustful and suspicious. Other features include:

• thinking other people are lying to them or trying to manipulate them
• feeling they cannot trust their friends and associates
• worrying that any confidential information shared with others will be used against them
• thinking there are hidden meanings in remarks most would regard as innocent
• worrying that their spouse or partner is unfaithful, despite a lack of evidence

Schizoid personality disorder

Someone with a schizoid personality disorder may appear cold and detached. They may also avoid making close social contact with others. Other features include:

• preferring to take part in activities that do not need interaction with others
• having little desire to form close relationships, including sexual relationships
• being uninterested when receiving criticism or praise
• having a limited ability to experience pleasure or joy

Schizotypal personality disorder

A person with a schizotypal personality disorder is likely to:

• have poor social skills
• have delusional thoughts
• behave in unusual ways

Other features include:

• believing in special powers – like telepathy or the ability to influence other people’s emotions and actions
• having unusual ways of speaking – like long, rambling vague sentences or going off on a tangent
• experiencing excessive anxiety in social situations – even if they’ve known a particular person or group of people for a long time

A person may also attach undue and misguided significance to everyday events. For example, thinking newspaper headlines are secret messages to them.

Antisocial personality disorder

A person with an antisocial personality disorder sees other people as vulnerable. This means they may intimidate or bully others without remorse.

Symptoms include:

• lack of concern, regret or remorse about other people’s distress
• irresponsibility and disregard for normal social behaviour
• difficulty in sustaining long-term relationships
• little ability to tolerate frustration and control their anger
• lack of guilt, or not learning from their mistakes
• blaming others for problems in their lives

Borderline personality disorder

A person with borderline personality disorder:

• is emotionally unstable
• has impulses to self-harm
• has very intense and unstable relationships with others

Histrionic personality disorder

A person with a histrionic personality disorder is anxious about being ignored. As a result, they feel an overwhelming urge to be noticed. They also have the urge to be the centre of everyone’s attention.

Features include:

• displaying excessive emotion, yet appearing to lack real emotional sincerity
• dressing provocatively and engaging in inappropriate flirting or sexually seductive behaviour
• moving quickly from one emotional state to another
• being self-centred and caring little about other people
• constantly seeking reassurance and approval from other people

Symptoms and signs may co-exist with borderline and narcissistic personality disorders.

Narcissistic personality disorder

A person with narcissistic personality disorder swings between:

• seeing themselves as special, and
• fearing they’re worthless

They may act as if they have an inflated sense of their own importance. They may also show an intense need for other people to look up to them.

Other symptoms include:

• exaggerating their achievements and abilities
• thinking they’re entitled to be treated better than other people
• exploiting other people for their own personal gain
• lacking empathy for other people’s weaknesses
• looking down on people they feel are “beneath” them
• feeling deeply envious of people they see as being “above” them

Avoidant personality disorder

A person with avoidant personality disorder:

• appears painfully shy
• is socially inhibited
• feels inadequate
• is extremely sensitive to rejection

Unlike people with schizoid personality disorders, they desire close relationships with others. However, they lack the confidence and ability to form them.

Dependent personality disorder

A person with dependent personality disorder feels they can’t be independent. They may show an excessive need for others to look after them and are “clingy”. Other features include:

• finding it difficult to make decisions without other people’s guidance
• needing others to take responsibility over what should be their own life choices
• not being able to express disagreement with other people
• finding it difficult to start new activities due to a lack of confidence
• going to extremes to get support and comfort
• feeling helpless and uncomfortable when alone
• urgently needing to start a new relationship when one comes to an end
• having an unrealistic and constant fear they’ll be left alone to fend for themselves

Obsessive compulsive personality disorder

A person with obsessive compulsive personality disorder is:

• anxious about issues that seem out of control or “messy”
• preoccupied with orderliness and ways to control their environment

They may come across to others as a “control freak”.

Other features include:

• having an excessive interest in lists, timetables and rules
• perfectionism – being so focused on completing a task perfectly that they struggle to finish it
• being a workaholic
• having very rigid views about issues like morality, ethics and how a person should behave
• hoarding items that seem to have no monetary or sentimental value
• being unable to delegate tasks to other people
• disliking spending money, as they think it’s always better to save for a “rainy day”

Differences to obsessive compulsive disorder (OCD)

This personality disorder differs from obsessive compulsive disorder (OCD).

People with OCD are aware that their behaviour is abnormal and are anxious about it. Whereas, most people with obsessive compulsive personality disorder think their behaviour is acceptable. They usually have no desire to change it.

Some people with OCD feel the need to carry out rituals. For example, having to touch every second lamppost as they walk down the street. This is not usually the case with people with obsessive compulsive personality disorder.

People with OCD may feel the need to make lists or organise items in their house, but feel anxious about doing so. People with obsessive compulsive personality disorder feel less anxiety through such tasks. They may become irritated when prevented from doing so.

Treating a personality disorder

Many people recover from personality disorders over time.

Treatment usually involves a course of psychological therapy tailored to the individual. This treatment usually lasts at least 6 months. But, it may last longer depending on the severity of the condition and other problems.

Psychological therapies

Psychotherapy involves discussing thoughts, emotions and behaviours with a trained professional. The aim is to improve people’s ability to regulate their thoughts and emotions.

Some therapies focus on dysfunctional thoughts. Others focus on self-reflection and being aware of how your mind works. Some therapies, especially group therapies, help people understand social relationships better.

Psychological therapies can be effective for many personality disorders. But, they should only be delivered by a trained professional. They should have experience working with personality disorders and other conditions. This is because personality disorders can be associated with high-risk behaviours, like self-harm.

The psychotherapist will listen and discuss important issues with you. They can also suggest strategies to resolve problems. If necessary, they’ll help you change your attitudes and behaviour.

A range of different psychotherapies are used to treat personality disorders.

Read more about types of counselling and therapy

Medication

No medications are currently licensed for the treatment of any personality disorder. But, medications may be prescribed to treat associated problems, like:

• depression
• anxiety
• psychotic symptoms